Is early intervention for ASD actually prevention?

As the average age at which early signs and symptoms of autism and diagnosis moves becomes younger and younger, methods for intervening at autism at the earliest possible ages are becoming more widely used. At this year’s IMFAR meeting, several clinicians and researchers addressed differences in design, methods, and identified challenges and potential solutions for delivering intervention from individuals with ASD as young at 10 months of age. Since this is when very early symptoms of ASD can be detected, but not yet diagnosed, many are considering this as a method of prevention rather than intervention. A feasible and cost-efficient way to provide interventions to infants and toddlers is to engage parents and train them to use behavioral techniques to improve development. What works for adolescents and adults does not apply to infants and toddlers. Instead of spending time working on specific tasks and skillsets, clinicians work with parents and provide ongoing support to engage children in social, communication and motor skills during playtime activities. But does this prevent ASD?

The simple answer is that it is very complicated. As reported in an earlier report, one size does not fit all. There may be a number of variables that affect outcome. In addition, last year, a report out of the UK last year reported that parent-mediated interventions did not result in a change in diagnostic status in young children. This same group showed new data at IMFAR this year showing that the intervention was effective in some ways – infants showed increased attention and gestures as well as improved shared interest. These early improvements are thought to lead to a higher level of functioning later on.

Children with ASD suffer from impoverished social interaction, and parents can be instrumental in providing stimuli to their children to change behavior. Most interventions now focus on encouraging parents to actively engage the child using evidence based strategies, in natural environments. Other types of interventions that were used included promoting behaviors and responsiveness in the context of everyday routines.

Given that published research don’t actually prevent ASD, but improve long-term outcomes, is the goal of early interventions to reduce the incidence of ASD? Alice Carter, member of the Autism Speaks Toddler Treatment Network noted that earlier screening and delivery of parent interventions which improve joint attention, and coordinated attention between parent and child – may prevent symptoms down the road, but may not always lead to a change in diagnosis. She stated “working with parents can make a huge difference in many children’s lives.”

Improved outcome measures which are more sensitive to improvements over time on a number of domains need to be developed to better describe these differences. In addition, working with a young child at home is difficult in any situation, and especially for families affected by ASD. Therefore, methods and techniques to maximize the amount of time parents deliver effective interventions are considered a priority. Autism Speaks is proud to sponsor this network in thinking about these important issues.

As an early intervention practitioner I see the importance of intervening early and how intensive hours of services are at times needed in order to help children achieve their milestones. My issue is with funding. Early intervention is one of nine federally mandated, but not funded program. When studies came out indicated that early is everything in the field of autism (it is the case for other conditions as well) logically the burden of service delivery fell on early intervention programs. However, the level of funding provided by States often did not balance with the rising cost of EI, and as a result some States are now cutting funds. My question is, if we recognize that early intervention is strongly needed, isn’t time to talk about how it is funded?

The sooner the one on one sessions can start the better. We’re in Cape Town, South Africa and our son was diagnosed in 2008 he was 3 y 5 months. We took him to Snap in Durbanville, Cape Town and we also did speach, occupational and phisio therapy with Michael for 3years. He at that time was none responsive and now in 2011 he’s in grd 1, still at Snap (special school for autistic children) and we’ve now been given the green light for Michael to attend normal main stream schooling from 2012.

Now the challenge starts, because most schools in South Africa are not really willing to take these kids, even when they’re not taking any meds for autism. Teachers are uninformed about ASD and not willing to learn more about ASD.

I wouldn’t call it prevention, I will call it action!!! Action to cut the severity of the episodes and to help the individual and family understand the disorder as early as possible, to empower them with tools and strategies that can really …make a big difference as an individual and as member of the family and community. Early Action to recognize triggers and symptoms and how to handle the tantrums , how to deal with there frustration because of lock of communication abilities, the early you learn to understand the individual and his/her strengths and weaknesses, likes and dislikes, sensory issues etc. ; and the individual itself learn to recognize a way to express him/herself and integrated with their abilities will open a new windows of opportunities in their lives to be the best they can be… With support, the right individualize program, therapies and a lot of love and patience, no matter the complex of the disorder there is always a way!!! Your job as a parent or professional is to look deep and find the spark that will light there life!!!

I have 6 year old who was dignosed with autism at the age of 2and I was shocked myself I blame me because it runs on myside of the familiy but then I learned its not my fault or anyone it just happens so now after all the early intervention and our school tht works very hard with him and all tht he’s come alongway and he’s just has he’s own peronality and funny so I’m very proud of how far he’s come along•and I wouldn’t have it any other way I love him very much I put all my kids before me and whtevr they need I try get or do something to try •

I quite agree that early intervention can be prevention. Based upon my recent research to find the cause, I found nutritional deficiencies to be the cause. If we can review the nutritional adequacy of the child’s diet early, changes can be made to eliminate the deficiencies that are known to give rise to the symptoms of autism. This is prevention that would spare the parents and children pain as well as financial ruin. Should the child’s diet pose a high risk of causing deficiencies of the nutrients essential for proper brain development and function this problem can be quickly overcome before any symptoms appear.

More than 90% of those in my study of over 1,000 reported feeding diets that were lacking many critical nutrients. It seems that what one believes to be well balanced often is absent critical nutrients. If the diet is limited in or lacking the cholesterol containing foods there will be several missing nutrients critical to the integrity of the myelin sheath, the membrane that insulates the nerves.

Early intervention (joint attention, etc.), coupled WITH medical interventions, is my dream (and I’m sure the dream of all the other science geeks on this blog). As science is not there yet with proven biomedical interventions for each subtype (http://www.ucdmc.ucdavis.edu/mindinstitute/research/app/), this is why these kids who are identified early are not coming off spectrum (and I don’t mean all – just some medical subtypes where biomedical treatment may be possible, e.g., fragile x and protein manipulation). Of course you know that.

Right Sarah,
My son had the very best behavioral intervention program yet during this time and $100,000 dollars later my son lost every skill he had due to chronic and undiagnosed illnesses.
We need to get past this ideas that ASD is a behavioral disorder and that good cognitive interventions are all we need.
Rather than spending 10s of millions on endless genetic research I would rather see that money spent on parent education and support for home programs. The cost yield benefit would be tremendous. And that benefit would be practically immediate.

However, if we do not pair early behavioral interventions w/ appropriate medical interventions for the children who need it we are leaving out 25% of ASD children- who have almost no chance for progress w/ medical help. We cannot do that to my child or yours.
The AS Toddler Treatment Program has too many psychologists and psychiatrists and no enough clinicians, GI experts and no autoimmune specialists. That needs to change now.